Research suggests that regimen adherence for self-management of diabetes is a serious problem and reason for poor adherence may be rooted in low literacy, culture, and lifestyle. More research is needed in this area, as health literacy (HL) not only measures a person's ability to read and comprehend, but also the ability to act on medical instructions and information. This is particularly true for the African American community which suffers disparate impact from chronic illness. The substantive aim of this descriptive, mixed method study is to explore the effects of beliefs and culture on health literacy and ultimately the management of diabetes in AAs from four regions in South Carolina. Our methodological aim is to develop a reliable, valid and generalizable survey tool with items that represents cultural beliefs, values, experiences and preferences for health information. This study is innovative in that it acknowledges the heterogeneity of the AA community and will apply theoretically grounded models to guide the substantive and methodological aims. We will use focus groups and cognitive interviews in year one and instrument pre-testing and population survey implementation in years two and three. Findings from this study will guide the selection of messages and strategies that will be subsequently tested within targeted populations to improve health outcomes. This study can advance the science as it relates to promoting health literacy and disease management among vulnerable populations. PUBLIC HEALTH RELEVANCE: Health literacy is the ability to read, write, understand and act on health information. Poor HL is common among people with diabetes, especially African-Americans (AA), and may help to explain poor health outcomes. Understanding factors related to disease management among heterogeneous AA sub-groups are essential to design and testing of interventions to improve self-management practices and health outcomes and reduce disparities.